Jaundice that appears in a newborn <24 hour old is most likely nonphysiologic and needs further evaluation.
Jaundice typically presents on the 2nd-3rd day of life. It is usually first seen on the face and forehead then progresses caudally to the trunk and extremities.
Visible jaundice in the feet may be an indication to check bilirubin level.
Visual estimation of bilirubin level is often inaccurate and unreliable.
Danger signs in a newborn infant with jaundice includes changes in brainstem evoked auditory potentials, changes in muscle tone, seizures and altered cry characteristics.
The presence of any of the danger signs require prompt attention to prevent kernicterus.

Principles of Therapy

A TSB level >25 mg/dL (428 µmol/L) at any time is a medical emergency & indicates prompt hospital admission & initiation of treatment

For preterm infants, initiation of phototherapy or exchange transfusion depends on the gestational age

Gestational Age

(weeks)

Phototherapy

Exchange Transfusion

TSB (µmol/L)

TSB (mg/dl)

TSB (µmol/L)

TSB (mg/dl)

<28

86

>5

188-239

11-14

28-29

103-137

6-8

205-239

12-14

30-31

137-171

8-10

222-274

13-16

32-33

171-205

10-12

257-308

15-18

>34

205-239

12-14

291-325

17-19

Pharmacotherapy

IV immunoglobulin (IVIG)

In an infant with isoimmune hemolytic disease, administration of IVIG is recommended if the TSB is rising in spite of intensive phototherapy or the TSB level is within 2-3 mg/dL of the exchange transfusion level

May reduce the need for exchange transfusions in Rh & ABO hemolytic disease

Has been shown to decrease RBC destruction & limit the rate of increase in bilirubin levels in infants with Rh & ABO isoimmunization

Tin-mesoporphyrin

This drug prevents or treats hyperbilirubinemia by inhibiting production of heme oxygenase

Clofibrate

May help lower bilirubin levels in term infants with hyperbilirubinemia by increasing bilirubin elimination, when used in combination with phototherapy

Further studies are needed to further prove the efficacy of Clofibrate in neonatal jaundice

Phenobarbitone

Has shown potential for reducing bilirubin levels by stimulation of hepatic enzymes

There are limited studies proving Phenobarbitone’s safety & efficacy for the management of neonatal jaundice

Non-Pharmacological Therapy

Has been shown to be most effective in very small preterm infants & least effective in severely growth retarded full-term infants

Conventional phototherapy in the hospital should consist of irradiance in the blue-green spectrum (400-500 nm) of at least 15 µW/cm2/nm that is delivered to as much of the infant’s surface as possible

The wavelength at the blue-green spectrum lets light penetrate the skin well & be maximally absorbed by bilirubin

The most effective light sources for phototherapy are special blue fluorescent tubes or specially designed light-emitting diode light

Light tubes should be placed as close to the infant as possible (30-50 cm from the infant)

The infant should be placed in the supine position, naked except for diapers to expose maximum body surface area, & eyes should be covered

Intensive phototherapy, which consists of at least 30 µW/cm2/nm, should be started when TSB levels reach 3 mg/dL (51 µmol/L) above the level of conventional phototherapy or when TSB levels continuously increase by >0.5 mg/dL/hour (8.5 µmol/L/hour)

Additional body surface area exposure may be achieved by lining the bassinet with aluminum foil or a white cloth

Infant’s eyes should be properly protected during phototherapy to prevent retinal damage

Fluid supplementation is not given routinely but is based on infant’s weight loss, urine output & urine specific gravity

Exchange transfusion should be done immediately in any infant with jaundice & signs of acute bilirubin encephalopathy which include hypotonia or hypertonia, opistothonus, fever, poor feeding & lethargy, even if the TSB level is falling

In almost all cases, exchange transfusion is performed only when phototherapy fails to keep the bilirubin level below the exchange transfusion level

Trained staff should perform the procedure in a neonatal intensive care unit

Intensive phototherapy is recommended in preparation for an exchange transfusion

Children born to obese mothers are at increased risk of developing autism spectrum disorder (ASD) compared with children born to normal-weight mothers, according to data from a review and meta-analysis.

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies.

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies.